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Background Hepatitis B virus (HepB) infection remains a major cause of chronic liver disease, cirrhosis, and hepatocellular carcinoma across Asia. Despite the broad implementation of infant vaccination and expanding access to antiviral therapy, the burden remains substantial and varies widely among regions. This study aimed to assess the burden of HepB in Asia from 1990 to 2023.Methods We conducted a comprehensive comparative assessment of HepB burden across Asian regions (East Asia, South Asia, Southeast Asia, Oceania, Central Asia, and Highincome Asia Pacific) based on the Global Burden of Disease 2023. Case data and age-standardized rates were utilized to analyze the incidence, mortality, and disability-adjusted life-years (DALYs) of HepB by age and gender. To capture longterm trends, we evaluated percentage changes from 1990 to 2023 for incidence, deaths, and DALYs.Results In 2023, the burden of HepB varied markedly across Asia. Incidence ranged from 0.23 million cases (95% uncertainty interview [UI]: 0.18–0.28) in Oceania to 21.29 million (95% UI: 16.30–26.63) in East Asia. Mortality and DALYs followed a similar pattern, with the lowest in Oceania and the highest in East Asia. Across all regions, males had substantially higher incidence, mortality, and DALY counts than females. Agespecific peaks differed by region: 50–59 years in East Asia, 35–44 years in South Asia, and 45–54 years in Southeast Asia. China contributed the highest number of incident cases in 2023, followed by India and Indonesia; this ranking was consistent for deaths and DALYs. However, Oceania recorded the highest age-standardized incidence rate at 1,528.50 per 100,000 (95% UI: 1,162.00–1,901.60), while South Asia had the lowest (590.40; 95% UI: 475.00–701.90). For the age-standardized death rate, Southeast Asia showed the highest rate (11.84; 95% UI: 9.70–13.78) and High-income Asia Pacific the lowest (4.33; 95% UI: 3.69–4.99). From 1990 to 2023, incident cases increased in Oceania (+32.9%) but declined in Highincome Asia Pacific (–26.9%) and East Asia (–27.6%). Mortality rose in Southeast Asia, Oceania, and Central Asia, while DALYs increased in Southeast Asia but declined in East Asia and Highincome Asia Pacific.Conclusions HepB continues to impose a substantial and uneven burden across Asia. Distinct regional trends, sex disparities, and agespecific patterns highlight the need for regiontailored vaccination, testing, and treatment strategies to advance toward HepB elimination goals.